Colonization as a Determinant of Health
Alexandra Thomas, MClSc, Western University
“It is important to note that colonization is not a singular, historical event, but a persistent and complex constellation of intersecting environments, systems, and processes intended to entrench social, political, and economic determinants that benefit white settler societies, often to the detriment of Indigenous lands, waters, cultures, communities, families, and individuals.” (Loppie, & Wien, 2022)
Understandings of health in Canada (or on Turtle Island) have historically been founded on Eurocentric knowledge, which have been designed and led by settlers and upheld overtime through the exclusion of Indigenous people (Reading & Wien, 2009; Boot & Lowel, 2019). Indigenous understandings of health and wellness extend beyond the physical body and recognize the environment and the connection to those who share the land. The interconnected relationship of family, culture, and the environment provides health and wellness sources among many Indigenous populations. Unlike in Western medicine, where health is frequently viewed as the absence of disease, and wellness refers to methods to enhance and maintain health (Stoewen 2015). This way of thinking and practicing health rejects the connection to the broader environment (Curtis et al., 2019). Even in the wealthiest of nations, like Canada, health inequities exist among subgroups of populations Adelson, 2005). In the search of identifying the “causes of causes,” or the root of an illness, a more recent framework within the health sciences, the social determinants of health, looks to understand the nuances of ill-health experiences as a mechanism to foster health equity.
The social determinants of health are the social, political, and economic factors that impact one’s health and wellbeing, or the “conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life....” (WHO, 2021, para. 1). These determinants, including but not limited to, gender, socioeconomic status, physical environments, and social supports, all contribute to the experience of health and wellness. Such determinants are considered proximal determinants, meaning they have a direct impact on one’s health. Within the Canadian public health context, Indigenous identity is identified as one of the fourteen social determinants of health, insinuating one’s identity or ethnicity will lead to poorer health outcomes (Mikkonen, & Raphael, 2010). While social determinants may address the many conditions and factors that contribute to health equity, it fails to acknowledge the context in which we achieve health and wellness (Lines, Yellowknives Dene First Nation Wellness Division. & Jardine, 2019). Adaptations of this framework have included colonialism and racism as distal determinants, or indirect influences, despite the continuation across institutions in which we still see today (Greenwood & de Leeuw, 2012). Settler-colonialism shapes the health systems imposed on Indigenous communities, and the subsequent health outcomes inevitably reflects the everlasting impacts of settler invasion and Indigenous resistance (Wispelwey et al., 2023).
The experience of health inequities on this territory we call Canada is rooted in the legacy of the socio-historical realities of colonialism, racism and the systematic suppression of traditional Indigenous health knowledge and healing practices (Allen et al., 2020). The continuation of this knowledge across healthcare facilities is based on social stratification, rooted in colonisation, that marginalizes and excludes Indigenous identities, contributing to the inequitable experiences of health and wellness (Schultz et al., 2021; Asadullah et al. 2022). Compared to the general Canadian public, Indigenous populations are overrepresented in the population of those incarcerated, overrepresented in the child welfare system, have a lower life expectancy, have higher rates of morbidity and mortality, and are more likely to die prematurely of avoidable deaths. The over-policing and underserving of Indigenous populations within colonial structures are the long-lasting symptoms of colonialism which contribute to adverse health effects (Singh, Prowse & Anderson, 2019; Sinha et al., 2013; Michalowski & Loh, 2005; Park 2021).
Often the health of indigenous people is not adequately considered in relation to others in the society. Canadian-imposed colonial practices reach back over 400 years, dismissing the voices, personhood, experiences, and knowledge of Indigenous peoples. Throughout Canada’s history, institutions have been led by settlers, informed by western knowledge, and by no coincidence, have contributed towards the cultural genocide of Indigenous peoples. Institutions have removed Indigenous peoples from their family and community, their culture, and their land. Throughout history, we continue to see acts of colonial violence, whether it was from starving those who refused to assimilate, tearing families apart through Indian Residential Schools, placing children into the homes of non-Indigenous families, or forced sterilization of women, and so on. Each horrific act was founded on western knowledge and implemented by settlers across Canadian institutions as acts of colonial violence, creating intergenerational impacts on the health and well-being of Indigenous communities (Matheson et al., 2022; Strong-Boag, 2010).
Emerging discussions within public health are changing the narrative surrounding Indigenous ethnicity as a risk factor, but rather, being subjected to colonial health structures is associated with adverse health outcomes. Indigeneity brings wellness and connects those to the broader community, culture, and environment. In contrast, colonial practices have disrupted health practices, creating irreversible damage. The experience of racism and colonial violence is interconnected across Canadian institutions. This experience is both immediate and intergenerational (Hendry & Braley, 2024; Allan, & Smylie, 2015). To best understand health inequities, we must consider the context in which knowledge and practices. The adverse health experiences faced by Indigenous populations are not rooted in the participation of Indigenous culture and practices, rather the opposite - it is Western knowledge that views Indigeneity as a risk factor (Loppie, 2022). When we provide the context of colonialism as a determinant of health, we also recognize the colonial scripts and violence that are embedded across systems which disrupt Indigenous ways of knowing and doing and subsequently lead to adverse health outcomes (Hendry & Braley, 2024). In recognizing being subjected to colonial structures as a determinant of health, self-determination and Indigenous solidarity may be viewed as acts of health promotion.
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